NDLI: Can diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch (positive diffusion-weighted imaging/negative fluid-attenuated inversion recovery) at 3 Tesla identify patients with stroke at <4.5 hours?

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Can diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch (positive diffusion-weighted imaging/negative fluid-attenuated inversion recovery) at 3 Tesla identify patients with stroke at <4.5 hours?

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Can diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch (positive diffusion-weighted imaging/negative fluid-attenuated inversion recovery) at 3 Tesla identify patients with stroke at <4.5 hours?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Pombourcq, Francis Oppenheim, Catherine Emeriau, Samuel Serre, Isabelle Toubas, Olivier Pierot, Laurent
Description	Country affiliation: France Author Affiliation: Emeriau S ( Department of Neuroradiology, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.)
Abstract	BACKGROUND AND PURPOSE: At 1.5 T, diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch helps identify strokes within 4.5 hours of onset. However, at 3T, studies have found divergent results. The goal of this study was to determine whether DWI-FLAIR mismatch at 3T would also be helpful for identifying patients within 4.5 hours of symptom onset. METHODS: All patients presenting with an ischemic stroke in the middle cerebral artery territory and explored with 3T MRI within 12 hours between November 2007 and April 2012 were included in this retrospective study. Two readers analyzed the DWI and FLAIR images. Logistic regression was performed to determine independent predictors of FLAIR visibility. Also, the predictive values of a mismatch for identifying patients with stroke onset ≤4.5 hours were estimated. RESULTS: The study included 194 patients. The only predictive factor of FLAIR visibility was delayed MRI acquisition. The DWI-FLAIR mismatch was able to identify patients within 4.5 hours of stroke onset with relatively low sensitivity (0.55; 95% confidence interval, 0.48-0.63), low specificity (0.60; 95% confidence interval, 0.42-0.77), high positive predictive value (0.88; 95% confidence interval, 0.82-0.94), and very low negative predictive value (0.19; 95% confidence interval, 0.11-0.28). In addition, 44.5% of patients had a positive FLAIR sequence within 4.5 hours. CONCLUSIONS: This study improves our understanding of DWI-FLAIR mismatch as an imaging biomarker for wake-up management of patients with stroke. At 3T, the presence of a DWI-FLAIR mismatch was able to identify stroke onset of <4.5 hours. However, 44.5% of such stroke cases demonstrated FLAIR signal changes.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	6
Volume Number	44
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2013-06-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Cerebrovascular Circulation Physiology Diffusion Magnetic Resonance Imaging Hemodynamics Middle Cerebral Artery Physiopathology Stroke Diagnosis Pathology Disease Management Logistic Models Predictive Value Of Tests Roc Curve Retrospective Studies Sensitivity And Specificity Time Factors Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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